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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />N Colo Water Conservancy Dist <br />M-1981-085 <br />Riprap Quarry Area <br />July 21, 2002 <br />$688.00 (Due on or before your anniversary date) <br />Grand <br />RECEIVED <br />JUL 0 3 1002 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br />-- --operator-shall-submit- the-annual-fee,- a-report- and-map-showing the-r~ctem-ef-current-disturbances-to-affected <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming yeaz, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual report map to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written <br />report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Jerry A. Westbrook <br />Pemuttee Name: N Colo Water Conservancy Dist <br />Address: P.O. Box 679 <br />Loveland, CO 80539 <br />Phone Number: (970) 667-2437 <br />Fax Number: (970) 663-6907 <br />If you have additional comments and/or information that should be provided [o the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />e <br />St to Co eFate Officer or Own <br />7~Z~oz <br />Date <br />M:NERM771MASTERD000M EMSN-I-AF-04 <br />